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Question: We are thinking of going through an IVF, but we are concerned whether IVF babies have higher risk of abnormalities. We are also concerned that IVF babies are less healthy than their counter-parts and have shorter life-span, is it true?

Dr Helena’s answer:

Since the advent of IVF and Assisted Reproductive Technology, there had been constant debates on its safety and implication towards the health of the next generation. One of the biggest concerns is whether these fertility treatment will give rise to increase risk of congenital abnormalities in babies born as a result of IVF.

These debates and concerns are certainly valid. After all, the process of IVF in creating life outside human body in a Petri dish and then putting them back into the human body to let it grow into a baby is certainly mind blowing. How would we ensure that the doctors and scientists know what they are doing? And mind you, the IVF process were the results of many trials and errors. What makes you think the product (which is the baby), is not plagued with defects and errors?

Intensive research in the early years, and a thriving population that has now grown to more than 5 million IVF children worldwide, have reassured scientists, but they have not stopped studying and trying to improve the process.

Recent discoveries in epigenetics – the study of how environmental factors can affect gene activity, and how a person’s risk of getting chronic diseases is “programmed” into them before they are even born – have opened up new possibilities.

Much of today’s research stems from the Barker hypothesis, which proposes that birth weight may be linked to the likelihood of getting certain diseases. IVF babies are known to have lower average birth weights – even if the difference, at about 20-30 grams, is small. Scientists are now investigating whether IVF conception equates with more hospital admissions, and an increased risk of cardiovascular disease, high blood pressure and diabetes in later life. However, there is no good evidence as yet to suggest likewise

A recent study by the Human Fertilization and Embryology Authority, which linked 106, 381 HFEA register records from 1992-2008 to the UK’s National Registry of Childhood Tumours (NRCT) is one of the largest population-based linkage studies ever carried out. This study has found no association between ART and childhood cancer. This finding offers comfort to those patients facing the difficult decision about whether to undergo fertility treatment or not.

In 2012, scientists at the University of California, Los Angeles (UCLA) looked at birth defects among infants born both via IVF and conceived through natural means in California, which has the country’s highest rate of IVF use. They included babies born after IVF and other assisted reproductive treatments such as couples’ use of fertility-enhancing drugs and artificial insemination.

Among 4795 babies born after IVF and 46,025 infants who were conceived naturally, 3,463 babies had congenital birth defects. Even after controlling for factors that can affect such birth defects, such as mother’s age, and race, which can influence rates of genetic and environmentally driven developmental disorders, 9% of infants born after IVF had birth defects compared to 6.6% of babies who were conceived naturally. Overall, the babies born after IVF were 1.25 times more likely to be born with abnormalities. The researchers did not find a link between birth defects and other fertility treatments like artificial insemination or ovulation induction.

It’s possible that the higher rate of abnormalities with IVF is due in part to whatever was contributing to infertility in the first place, say the researchers. But some of the researchers’ view was the fact that an increase was not seen among babies conceived using artificial insemination or ovulation induction suggests that process of IVF itself, in which eggs are removed from a woman, fertilized in a dish with sperm and then allowed to develop into embryos, which are transplanted back into the womb, is the primary culprit.

However, another more recent study in 2016 by researchers from the University of Adelaide and the University of Melbourne. The study reviewed all assisted reproduction technologies carried out in South Australia over a 16-year period from 1986 to 2002.

This was linked to data on birth outcomes from the South Australian Birth Defects Register (SABDR). The register includes a record of all live births, stillbirths, terminations, birth weight and congenital defects. Birth defects were also followed up for five years. The researchers looked at the statistical link between maternal factors and birth defects, and compared this between babies either conceived naturally or by IVF and ICSI. The study found no statistically significant increase in birth defect. There was some suggestion by the press that this study suggest that IVF reduces the incidence of birth defect in women after the age of 40, but was refuted by the research group due to its misleading nature.

With the advent of Pre-implantation genetic screening (PGS) & Pre-implantation genetic diagnosis (PGD), which is fast gaining popularity, scientist can now screen embryos to exclude chromosomal and genetic abnormalities. The use of these technologies may further decrease the incidence of birth defect and congenital abnormalities associated with chromosomal defects or genetic issues. However, more long term data is required to support this hypotheses.

In conclusion, although there had been great hypothetical concerns about the risk of cancers & birth defects amongst babies born following Assisted Reproductive Technologies (ART), the actual link is difficult to establish due to many confounding factors such as parental age, the cause of infertility and etc. the actual incidence of childhood cancers and birth defects are small and should not be a great stumbling stone to those who are considering going through fertility treatment to have their babies

Couples who are struggling with infertility often seek In-Vitro Fertilisation (IVF) treatment in order to improve their chances of starting a family. But what happens when you have gone through multiple unsuccessful IVF cycles? Is there something else you can try?

Many patients who’ve experienced this first hand, have asked me this question, eager to try out something new to enhance their chances in the next IVF cycle. Therefore, today, I’d like to tell you more about a procedure called endometrial scratching, which has become increasingly popular in recent years.

What is it?

Endometrial scratching is a procedure that involves agitation of the endometrium, which is the mucus membrane that lines the uterus. For conception to occur, a fertilised egg has to successfully implant itself into the wall of the uterus. Sometimes, implantation fails, usually due to the quality of the embryo or the receptivity of the endometrium. In endometrial scratching, a fertility specialist passes a special thin catheter or pipille through a woman’s cervix. The pipille is then moved up and down to gently make tiny scratches or scrapes in the uterine lining. The similar effect can also be achieved by introducing a hysteroscope through the cervix to visualised the lining of the uterus during polyps removal.

Why is it done?

In theory, endometrial scratching is believed to trigger the uterus to repair itself and develop a new lining, which will be more receptive to an embryo implanting. While the effectiveness of the procedure needs further investigation, studies that have been done on endometrial scratching in recent years have shown encouraging results.

One such study was conducted by the University of Nottingham, UK, which involved 158 women who had undergone unsuccessful IVF procedures. The women were divided into two groups, with one group given the endometrial scratching procedure. As a result, they found the women who had undergone the scratching procedure achieved a 49% pregnancy rate, compared to 29% in the other group.

In another study involving 1000 women, presented at the annual meeting of European Society of Human Reproduction and Embryology (ESHRE), endometrial scratching is said to increase pregnancy success rates for couples trying to conceive naturally or with Intrauterine Insemination (IUI).

When is it done?

The endometrial scratching procedure is usually recommended for patients who’ve experienced multiple unsuccessful IVF cycles or Intracytoplasmic Sperm Injection (ICSI) treatment. The procedure is best performed prior to a woman’s period or right after the period. It is done before an IVF or frozen embryo transfer (FET) cycle begins.

Does it hurt?

While the endometrial scratching procedure has been described as generally painless, requiring no anaesthetic, some women do experience discomfort during and after the procedure. The pain is similar to period cramps and there may be slight bleeding afterwards. To help with possible discomfort, patients are advised to take over-the-counter pain medication about an hour before undergoing the scratching procedure.

If you’ve gone through several IVF attempts and are keen on learning more about endometrial scratching, take the next step and ask your fertility specialist if it is right for you.

We all know that staying physically active is beneficial to our overall health and wellbeing. But did you know that the right amount of exercise can also improve your chances of conceiving? Here’s why.

Firstly, regular exercise is known to help optimise the reproductive system. It does this by stimulating the endocrine glands, which releases hormones that help your eggs to grow. Secondly, exercise can enhance your metabolism and circulation, which in turn optimises your egg production.

Thirdly, exercise can help you manage or achieve an ideal body weight. Since being overweight or obese can impair fertility in both men and women, weight management is widely known and used to prevent and treat infertility. And lastly, regular workouts also help to relieve stress, which in itself can inhibit fertility.

While regular moderate exercise can have positive effects on fertility and conception, the opposite is true for vigorous exercise. According to a 2009 study in Human Reproduction, and a Harvard study of elite athletes, vigorous exercise is linked to reduced fertility and pregnancy rates. Therefore, when it comes to exercise and fertility, it is possible to have too much of a good thing.

While there are no guidelines for women to follow when it comes to workout intensity for fertility, there is a way to strike a balance. Studies have shown that women who exercised moderately for at least 30 minutes a day can reduce their risk of infertility due to ovulation disorders. Evidence also suggests that moderate regular exercise can positively influence assisted reproductive technology (ART) outcomes. But what is the right amount of exercise?

If you’re already at your ideal weight, it is safe to stick to your regular routine, but keep it to half an hour maximum per day. Studies had shown that vigorous aerobic exercise of more than 4 hours per week reduces the chance of pregnancy in women going through IVF. If your cycle is still irregular and you haven’t conceived after a few months, you might want to cut back on the intensity of your workouts. However, if you’re underweight, focus on gaining weight and increasing your body fat to the recommended amount of over 12%. If you exercise regularly, cut back on the frequency and opt for a less vigorous routine.

Meanwhile, if you’re overweight, work on cutting down on your calories with healthy eating. You can also increase your exercise routine gradually to achieve your ideal weight. Lastly, if you’re undergoing fertility treatments, it is best to avoid high-impact exercises, as they can be detrimental to your ovaries, which have been enlarged by fertility drugs.

Still have doubts on where to begin? Before you step up your exercise routine, start by speaking to your doctor. If you’ve been having trouble conceiving, your doctor will need to assess your condition first. This includes your age, cycles, ovulatory status, the condition of your uterus and tubes, as well as your partner’s sperm. Once certain conditions have been identified or ruled out, your doctor will be able to advise you on whether the underlying cause may be too little or too much exercise.